Jeremiah's Franchisee Questionnaire

Tell Us About Your Company
Company Legal Name*
Business Structure*
"Other" Business Structure:
Number of Owners/Members/Partners*
Company FEIN*
Primary Business Contact*
First Last
Primary Contact Phone*
Primary Contact Email*
Mailing Address*
Where would you like to receive mail?

Street Address Address Line 2 City State ZIP Code

Tell Us About Your Jeremiah's Location(s)
Number of Locations to be Insured?*
Location #1 Details
Physical Address of Location #1*
What is the address of your Jeremiah's location?

Same as Mailing

Street Address Address Line 2 City State ZIP Code
Is this location currently insured?*
Is there a lender associated with this location?*
Is this location currently open?*
Actual Opening Date L#1*
MM slash DD slash YYYY
Projected Opening Date L#1*
MM slash DD slash YYYY
Is This Location:*
Building Size #1*
Total square footage of the owned building
Leased Space Size L#1*
The total square footage of the leased premise.
Projected Build-Out Cost L#1*
Total value of tenant improvements, including any TI allowance from landlord. Please do not include equipment, furniture, or inventory.
Location #2 Details
Physical Address of Location #2*
What is the address of your Jeremiah's location?

Same as Mailing

Street Address Address Line 2 City State ZIP Code
Is this location currently insured?*
Is there a lender associated with this location?*
Is this location currently open?*
Actual Opening Date L#2*
MM slash DD slash YYYY
Projected Opening Date L#2*
MM slash DD slash YYYY
Is This Location:*
Building Size #2*
Total square footage of the owned building
Leased Space Size L#2*
The total square footage of the leased premise.
Projected Build-Out Cost L#2*
Total value of tenant improvements, including any TI allowance from landlord. Please do not include equipment, furniture, or inventory.
Location #3 Details
Physical Address of Location #3*
What is the address of your Jeremiah's location?

Same as Mailing

Street Address Address Line 2 City State ZIP Code
Is this location currently insured?*
Is there a lender associated with this location?*
Is this location currently open?*
Actual Opening Date L#3*
MM slash DD slash YYYY
Projected Opening Date L#3*
MM slash DD slash YYYY

Tell Us About Your Company

Tell Us About Your Jeremiah's Location(s)

Location #1 Details

Location #2 Details

Location #3 Details

Tell Us About Your Operations

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